Practice Patterns for Acute Ischemic Stroke Workup: A Longitudinal Population-Based Study

Matthew C. Loftspring, Brett M. Kissela, Matthew L. Flaherty, Jane C. Khoury, Kathleen Alwell, Charles J. Moomaw, Dawn O. Kleindorfer, Daniel Woo, Opeolu Adeoye, Simona Ferioli, Joseph P. Broderick, Pooja Khatri

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

BACKGROUND: We examined practice patterns of inpatient testing to identify stroke etiologies and treatable risk factors for acute ischemic stroke recurrence.

METHODS AND RESULTS: We identified stroke cases and related diagnostic testing from four 1-year study periods (July 1993 to June 1994, 1999, 2005, and 2010) of the Greater Cincinnati/Northern Kentucky Stroke Study. Patients aged ≥18 years were included. We focused on evaluation of extracranial arteries for carotid stenosis and assessment of atrial fibrillation because randomized controlled trials supported treatment of these conditions for stroke prevention across all 4 study periods. In each study period, we also recorded stroke etiology, as determined by diagnostic testing and physician adjudication. An increasing proportion of stroke patients received assessment of both extracranial arteries and the heart over time (50%, 58%, 74%, and 78% in the 1993-1994, 1999, 2005, and 2010 periods, respectively; P<0.0001 for trend), with the most dramatic individual increases in echocardiography (57%, 63%, 77%, and 83%, respectively). Concurrently, we observed a decrease in strokes of unknown etiology (47%, 48%, 41%, and 38%, respectively; P<0.0001 for trend). We also found a significant increase in strokes of other known causes (32%, 25%, 45% and 59%, respectively; P<0.0001 for trend).

CONCLUSIONS: Stroke workup for treatable causes of stroke are being used more frequently over time, and this is associated with a decrease in cryptogenic strokes. Future study of whether better determination of treatable stroke etiologies translates to a decrease in stroke recurrence at the population level will be essential.

Original languageEnglish
JournalJournal of the American Heart Association
Volume6
Issue number6
DOIs
StatePublished - Jun 23 2017
Externally publishedYes

Keywords

  • acute stroke
  • evidence‐based medicine
  • population

Fingerprint Dive into the research topics of 'Practice Patterns for Acute Ischemic Stroke Workup: A Longitudinal Population-Based Study'. Together they form a unique fingerprint.

  • Cite this

    Loftspring, M. C., Kissela, B. M., Flaherty, M. L., Khoury, J. C., Alwell, K., Moomaw, C. J., Kleindorfer, D. O., Woo, D., Adeoye, O., Ferioli, S., Broderick, J. P., & Khatri, P. (2017). Practice Patterns for Acute Ischemic Stroke Workup: A Longitudinal Population-Based Study. Journal of the American Heart Association, 6(6). https://doi.org/10.1161/JAHA.116.005097